1
|
Abstract
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.
Collapse
|
2
|
van Lanen RHGJ, Hoeberigs MC, Bauer NJC, Haeren RHL, Hoogland G, Colon A, Piersma C, Dings JTA, Schijns OEMG. Visual field deficits after epilepsy surgery: a new quantitative scoring method. Acta Neurochir (Wien) 2018; 160:1325-1336. [PMID: 29623432 PMCID: PMC5995984 DOI: 10.1007/s00701-018-3525-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
Background Anterior temporal lobectomy (ATL) as a treatment for drug-resistant temporal lobe epilepsy (TLE) frequently causes visual field deficits (VFDs). Reported VFD encompasses homonymous contralateral upper quadrantanopia. Its reported incidence ranges from 15 to 90%. To date, a quantitative method to evaluate postoperative VFD in static perimetry is not available. A method to quantify postoperative VFD, which allows for comparison between groups of patients, was developed. Methods Fifty-five patients with drug-resistant TLE, who underwent ATL with pre- and postoperative perimetry, were included. Temporal lobe resection length was measured on postoperative MRI. Percentage VFD was calculated for the total visual field, contralateral upper quadrant, or other three quadrants combined. Results Patients were divided into groups by resection size (< 45 and ≥ 45 mm) and side of surgery (right and left). We found significant higher VFD in the ≥ 45 vs. < 45 mm group (2.3 ± 4.4 vs. 0.7 ± 2.4%,p = 0.04) for right-sided ATL. Comparing VFD in both eyes, we found more VFD in the right vs. left eye following left-sided ATL (14.5 ± 9.8 vs. 12.9 ± 8.3%, p = 0.03). We also demonstrated significantly more VFD in the < 45 mm group for left- vs. right-sided surgery (6.7 ± 6.7 vs. 13.1 ± 7.0%, p = 0.016). A significant quantitative correlation between VFD and resection size for right-sided ATL was shown (r = 0.52, p < 0.01). Conclusions We developed a new quantitative scoring method for the assessment of postoperative visual field deficits after temporal lobe epilepsy surgery and assessed its feasibility for clinical use. A significant correlation between VFD and resection size for right-sided ATL was confirmed.
Collapse
Affiliation(s)
- Rick H G J van Lanen
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - M C Hoeberigs
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N J C Bauer
- Department of Ophthalmology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R H L Haeren
- Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - A Colon
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
| | - C Piersma
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - J T A Dings
- Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
3
|
Ishikawa H, Niwa A, Asahi M, Matsuura K, Masuzugawa S, Niida Y, Maeda M, Kondo M, Tomimoto H. Diffusion tensor imaging and magnetic resonance spectroscopy in a patient with adult onset tuberous sclerosis complex. J Clin Neurosci 2018; 48:108-10. [PMID: 29129521 DOI: 10.1016/j.jocn.2017.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/23/2017] [Indexed: 11/20/2022]
Abstract
Tuberous sclerosis complex (TSC) 1 or TSC2 is mutated in most TSC patients. TSC2 mutations are more frequently associated with worse outcomes, earlier age at seizure onset, more severe intellectual disability, and higher tuber load than TSC1. The degree of white matter involvement is thought to be associated with the severity of neurological impairment. At present, genotype-phenotype correlations and relationship between tuber burden and neurological disability in TSC are debatable. We presented a 43-year-old patient with TSC2 mutation, whose symptom was only incomplete quadrantic visual field deficit in spite of multiple brain tubers. The visual field deficit was thought to be due to a small lesion in the upper medial part of the optic radiation revealed by diffusion tensor imaging. Her brain tubers showed normal findings in magnetic resonance spectroscopy. Our case suggested that neurological and neuropsychiatric manifestations of TSC are affected by the quality rather than number of the lesions. In addition, MRS may be useful to identify the correlation between brain tubers and neurological disability in TSC patients.
Collapse
|
4
|
Vachalová I, Gindl V, Heckmann JG. Acute inferior homonymous quandrantanopia in a 71-year-old woman. J Clin Neurosci 2013; 21:683-5. [PMID: 24210803 DOI: 10.1016/j.jocn.2013.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
A 71-year-old woman presented with acute inferior homonymous quadrantanopia initially mimicking acute ischemic stroke. As clinical signs and symptoms progressed to akinetic mutism with myoclonus the diagnosis of the Heidenhain variant of Creutzfeldt-Jakob disease was made. Brain MRI 4 days after symptom onset revealed ribbon-like high signal intensity in the medial occipital cortex.
Collapse
Affiliation(s)
- Ivana Vachalová
- Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, Landshut 84034, Germany
| | - Viola Gindl
- Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, Landshut 84034, Germany
| | - Josef G Heckmann
- Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, Landshut 84034, Germany.
| |
Collapse
|